Evaluation of Long-term Complications and Recurrence Rates in Ventral Hernia Repair With Component Separation

Abstract

PURPOSE: Ventral hernia repair (VHR) with concomitant component separation (CS) achieves better structural support in large fascial defect abdominal wall reconstructions. Traditionally, CS is performed by plastic surgeons but has recently become more popular in other specialties such as general surgery. Previous reports indicate that although CS reduces hernia recurrence, it is associated with an increased risk of complications. This study evaluates outcomes associated with VHR with CS (VHR + CS) compared to VHR alone and a subanalysis of VHR + CS outcomes stratified by plastic versus general surgeons. METHODS: A retrospective chart review of all VHRs between January 2009 and June 2017 at a single institution was performed. Demographic data, comorbidities, procedure details, length of stay (LOS), postoperative complications, and recurrence rates were recorded. Patients with <6 months follow-up or <30 cm2 defect size were excluded. Follow-up was defined as surgical follow-up, abdominal computed tomography or magnetic resonance imaging, or surgical visits with well-documented abdominal examinations. RESULTS: A total of 185 patients were identified: group I (n = 42) received VHR + CS and group II (n = 143) received VHR alone. Differences in defect size (217.4 versus 149.2 cm2; P = 0.02) and concurrent procedures (1.4 versus 0.9; P = 0.02) between groups I and II, respectively, reached significance. In addition, group I had significantly increased LOS (group I 15.0 days versus group II 4.6 days; P = 0.0049); however, no difference in postoperative complications (22.7% versus 21.6%; P = 0.89) or recurrence rates (22.7% versus 14.1%; P = 0.052) between groups I and II, respectively, was appreciated. Group I (n = 42), who received VHR + CS, was further stratified by specialty; group IA (n = 24) VHR + CS was performed by plastic surgeons, and group IB (n = 18) VHR + CS was performed by general surgeons. Differences in defect size (262.8 versus 149.6 cm2; P = 0.046) and concurrent procedures (1.7 versus 0.9; P = 0.047) were noted in groups IA and IB, respectively. There were no differences in recurrence rate (20% versus 20%; P = 0.656), LOS (8.8 versus 6.3 days; P = 0.33), or complication rate (29.1% versus 27.8%; P = 0.6) in groups IA and IB, respectively. CONCLUSION: Despite the use of CS in larger, more complex VHRs in our overall patient population, VHR + CS provides comparable outcomes in abdominal wall reconstruction at our institution. In our subgroup analysis, VHR + CS performed by plastic surgeons showed no difference in LOS, complication rates, and recurrence rates compared to general surgeons, despite larger defect sizes, more concurrent procedures, and more complex reconstructions performed in the plastic surgery cohort. Performance of VHR + CS is a viable approach to improving overall outcomes in patients with larger, complex hernias and may directly benefit from plastic surgery participation.